Sixty years on, it’s time to give the NHS a facelift
Last updated 09:14, Friday, 04 July 2008
When Nye Bevan set out his groundbreaking vision for the National Health Service 60 years ago tomorrow, he had three underlying principles.
These were that it was to meet the needs of everyone, be free at the point of delivery and be based on clinical need, not the person’s ability to pay.
Over the years the NHS has been shaped, moulded and revamped by various governments and has had more than its share of criticism. But all that aside, the original concept has remained the same.
Ultimately the health service has grown to become an invaluable lifeline for countless numbers of men, women and children living in the UK.
However times have moved on and there is no denying that it must now adapt to meet the changing needs of a new, convenience-led generation and an ever-aging population.
In Cumbria the foundation stones have already been laid for a massive shift in the way healthcare is delivered.
The Closer to Home masterplan, currently under development, sets out a new vision for the county which for years has been plagued by debt and lived in fear of service cuts, bed losses and hospital closures.
The aim is to move more services out of the big acute hospitals – allowing them to focus on providing a higher level of care – into community hospitals, GP surgeries and where possible, people’s homes.
If successful, it will create a system that offers optimum levels of care in the most appropriate setting for the patient.
And, perhaps just as importantly, success would create financial stability in the local NHS, lifting a massive weight from the shoulders of the local population, who have for years fought to save services.
The plans have not come without controversy, with initial fears about bed losses at the Cumberland Infirmary and the West Cumberland Hospital and the big changes ahead for staff among the main concerns.
But the fact that the Closer to Home plan will save all nine of north Cumbria’s doomed cottage hospitals, albeit with major transformations, is just one of the factors that has won over the general public.
Although there are still concerns, with uncertainty about some of the finer details, on paper the plan really could work.
Christine Wharrier is convener for health union Unison within the North Cumbria Acute Hospitals NHS Trust, which runs Carlisle’s Cumberland Infirmary and the West Cumberland Hospital.
She admits to initially having reservations about Closer to Home but now believes that, with the right funding and leadership, it could be a winner.
“The NHS has to change, there are no two ways about it. Our health service is the best thing in the world if it’s run right but at the moment it’s a beautiful dream that has just gone sadly wrong. It’s not working in terms of care and is just an open pit with money pouring into it,” she said.
“I think Closer to Home can work. There are some excellent ideas in there, for example people coming into hospital will be assessed properly and only admitted if they need to be, instead of being admitted just because they might breach the four-hour waiting target.
“Nobody wants to be in a hospital unless they really need to be. There are a lot of services we can move out into the community, leaving the acute hospitals for acute purposes.”
However she said one of her main concerns is that people receiving care in their homes may have to start paying for it after an initial period, whereas in the past they might have stayed in hospital for free.
She is also worried that health bosses may think of community-led care as the cheap option and not commit the resources needed to make the new system a success.
“It cannot be run cheaply, for example by using healthcare assistants instead of qualified staff. We need to be sure that the expertise is there. If these staff are put in place properly, with the proper funding and using common sense, then I think it will work.”
The acute trust’s medical director, Simon Raimes, said that major changes are on the cards but it will ultimately improve care for patients.
“The health service is moving. Quite a lot of investigations and treatments that we carry out in the acute hospitals could be done elsewhere,” he said.
“We particularly hope that in many cases elderly patients and those with chronic diseases won’t need to come into the main hospitals and can be treated in better environments, if possible their own homes.
“This means we will be able to run our services with fewer inpatient beds and concentrate our resources on patients who do have life-threatening conditions and need acute care.”
Mr Raimes said that the benefits of having fewer inpatient beds include smaller wards and more single rooms, which will improve privacy and reduce the risk of infections spreading.
There will also be opportunities to develop more specialist services and complex diagnostic processes currently only available outside the county.
However he admitted that putting the new strategy into place will be a challenge. This is because many of the trusts’ existing staff will be retrained and moved out into community settings, while less patients also means less money.
“We are in the early stages. These are big changes and are going to take a long time to deliver but I think people can see that they are sensible suggestions,” he said.
“I think staff are uncertain at the moment and that’s understandable. Their roles have been the same for a long time so they are not used to job changes. What we have to do is work with them so they know exactly what it will entail.”
Health professionals will now make the big decisions. That is what sold Closer to Home to Penrith GP Ian Mitchell, who chairs Cumbria Primary Care Trust’s professional executive committee.
Locality groups for each of the six Cumbrian districts have already been set up, comprising doctors, surgeons, social services staff, other health professionals and community figures, who will now decide how Closer to Home is implemented in each area.
“The responsibility for health provision and care is no longer held by faceless people,” enthused Mr Mitchell.
“It is now in the hands of the clinicians and people such as the Rev John Bannister in Copeland, people who are generally regarded as guardians of the public interest.
“Already 65 per cent of the county’s £800 million budget is now controlled by these locality groups.”
He added that the general public should start to see progress on projects, such as the redevelopment of cottage hospitals, by early next year.
In the Carlisle locality, which also covers Brampton, local GP Peter Weaving has been appointed lead member.
He said that there is currently a lot of work going on behind the scenes, some of which is already being consulted on.
This includes plans to create a new health campus in Brampton, incorporating the cottage hospital, GP surgery, a residential home and potentially some community facilities on one single site in the town.
In Carlisle plans have already been revealed to merge several existing practices to create two new medical centres in different parts of the city.
Work is also underway to create a new cottage hospital on the Cumberland Infirmary site – most likely developing the existing Reiver House building into a permanent step-up and step-down care facility. A similar project is also underway at the Whitehaven hospital.
But perhaps one of the biggest developments for Carlisle will be an overhaul of emergency care. This will be modelled on the system already in place at the West Cumberland Hospital, combining accident and emergency and out-of-hours GP care on one site.
The proposal is currently to redesign the front end of the infirmary and move the existing Cuedoc base at Hilltop Heights to the hospital site, creating an emergency treatment and assessment centre for all patients.
Dr Weaving believes these are all innovative ideas that will make it easier for patients and safeguard the NHS for the future.
“Two to three years ago we were in a situation where nine community hospitals were looking at closure because they were wasting money.
“Now the PCT has taken this great view that they are not the problem, but part of the solution and want to develop them in different ways to suit each of their patches,” he said.
“I think at the moment in Cumbria we are on the crest of a wave with a huge number of developments all about to burst into action. Ultimately it’s about creating a better experience for the patient and I think this will do that.”
